Increasing contraceptive use: FP as an enabling strategy for development in Uttar Pradesh, India

Contraceptive use in Hardoi District is the lowest in India, but when World Vision moved from FP/population messages to healthy timing and spacing messages, and reprogrammed FP activities as a secondary, enabling strategy within a broader development program, the CPR increased from 44% to 77% (67,989 MWRA) in four years. Data were collected and analyzed by India's National Institute of Family Welfare. WV organized women and men into Self Help Groups, and trained ASHAs * to train them to counsel on the essential MCH+FP interventions, using registers that outlined the rights messages to give, at the right time, during the first 1000 days. Because of high illiteracy, WV replaced printed words in the registers with colored icons and trained them to recognize their meanings. The SHG women registered pregnant and lactating mothers in ten households, gave them appropriate messages and wall charts with the same icons, arranged along a timeline, to reinforce these messages. They registered all other contraceptors, distributed condoms and pills, and referred to ASHAs for other methods. Male SHG members used the icons in their advocacy with men and religious leaders. Together they organized rallies and campaigns to change norms and support healthy behaviors. Couple counseling by couples was introduced later to ensure that husbands and wives heard the same messages, to improve couple communication and to reinforce individual counseling. *This training also strengthened the ASHAs' commitment to provide quality services to the SHG communities.